‘We have a new cold in town’

The medical evidence and experience of other countries show that swine flu is a mild infection with a very low fatality rate, epidemiologists said on Wednesday.

As a result, the government’s response, namely shutting down educational institutions, public gatherings and entertainment venues, has caused an unwarranted social and economic disruption, they said.

“Swine flu is a mild disease,” said Jayaprakash Muliyil, professor and head of the department of community health, Christian Medical College, Vellore, and one of India’s leading epidemiologists. “There is no need to close down schools. The response has gone out of hand. We have a new cold in town, that’s all.”

Another epidemiologist at a reputable organisation, who did not wish to be named because he is not authorised to speak to the media without prior permission, said that he would not have recommended that the government undertake such “drastic” measures. “But public awareness is very low and the authorities have to be seen as doing something,” he said.

In any case, they said the infection was impossible to contain. “Unless we freeze all activity and movement of people across the globe, this disease cannot be contained,” said Muliyil. “You can delay the infection, at most. You can’t block it.”

Experts explained that, like all flus, swine flu, although highly infectious, is, in the vast majority of cases, very mild. Most infected people will exhibit only mild symptoms.

Moreover, if people catch the swine flu, they will develop long-term immunity not only to the same virus but also to future ones that arise when the original undergoes a “genetic drift.”

“In this sense, getting infected may actually be a welcome event,” said Muliyil.

Said the other expert: “It’s as mild as the seasonal flu, which occurs year in and year out, and no one notices in our country.”

The data shows that the risk of dying from swine flu is miniscule. Globally, less than 0.5 per cent of those who are infected have died, the same expert said.

Even this percentage is an overstatement because many people who might be infected either do not develop symptoms at all or do not bother getting tested, so they do not figure in the data at all.

In some South American countries, a third of those infected did not exhibit symptoms, said the expert who did not wish to be named.

Then there are many who might test negative but are actually infected.

This is because the chances of testing positive in the method being used at all the designated centres (see box, Testing for swine flu) begins declining after three days following the virus’s entry into the respiratory tract, dropping to nil after a week.

Moreover, most people develop symptoms only a couple of days after the virus enters the system, and would think of going for a test only after that.

“As a result, you test positive only in a small window period,” said Muliyil.

In other words, the total number of infected people is actually much larger than the data indicates. This means that the fatality rate is probably much less than 0.5 per cent.

“When it first appeared in Mexico and the United States, all of us were frightened, because the flu can spread like wildfire,” said Muliyil. “But the question is, what is the case fatality rate?”

About 3 per cent of those infected (as indicated by the data), however, do develop severe symptoms, experts said.

But they are mostly those who already have serious health conditions, such as diabetes, hypertension and heart disease, or are pregnant or are on drugs that suppress the immune system.

The public may be panicking because, although the infection and fatality rates as a proportion of the population are low, the absolute numbers in a country like India are inevitably large.